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1 Alcohol Use Disorders in Homeless Populations NIAAA Social Work Education Module 10D (revised 3/04)

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Presentation on theme: "1 Alcohol Use Disorders in Homeless Populations NIAAA Social Work Education Module 10D (revised 3/04)"— Presentation transcript:

1 1 Alcohol Use Disorders in Homeless Populations NIAAA Social Work Education Module 10D (revised 3/04)

2 2 Outline A.Background Information about Homelessness B.Relationship of Alcohol Use Disorders and Homelessness C.Treatment of Alcohol Use Disorders among Homeless Populations

3 3 Definitions Literal homelessness:  No access to conventional dwelling  Cars  Emergency shelters  Abandoned buildings  Parks  Out-of-doors encampment (Source: Rossi et al., 1987) ©2002 Microsoft Corporation.

4 4 Definitions (continued) Precariously or marginally housed:  Tenuous or very temporary claims to dwelling  Doubling up with others  Single room occupancy (Source: Rossi et al., 1987) ©2002 Microsoft Corporation.

5 5 Definitions (continued) Adequate housing:  Protection from the elements  Access to potable water  Provision for removal of human/animal waste  Protection from intruders  Freedom from sudden removal/eviction (Source: Conroy, 1987) (Source: Conroy, 1987) ©2002 Microsoft Corporation.

6 6 Global Conceptualizations Lack of shelter  Roofless = India  Sin techo (without roof) = Latin America  SDF (sans domicile fixe, without fixed address) = United Nations (Source: Glasser, 1994) ©2002 Microsoft Corporation.

7 7 Global Conceptualizations (continued) Squatter settlements, spontaneous settlements:  bidonvilles (tin cities) = Francophone Africa  pueblos jóvenes (young towns) = Lima, Peru  kampung (village) = Indonesia

8 8 Cut off from household or other people:  clochard (tramp) = France  pennebruder (prison brothers) = Germany  furosha (floating people) = Japan  puliukko (elderly male alcoholic) = Finland  itinérants = Quebec Global Conceptualizations (continued)

9 9 Homeless street children:  gamino (gamin) = Columbia  pixote (from the movie Pixote) = Brazil  khate (rag picker) = Nepal ©2002 Microsoft Corporation.

10 10 Pathways to Homelessness Homelessness results from the interplay between:  Personal problems  mental health  alcohol/drug  Structural problems  urban renewal  gentrification  welfare changes  deinstitutionalization  prison release ©2002 Microsoft Corporation.

11 11 Alcohol and Homelessness  Relationship between alcohol and homelessness is interactive, iterative  Alcohol use problems are both a cause and and effect of homelessness  A portion of homeless individuals with alcohol problems also experience mental health problems mental health problems ©2002 Microsoft Corporation.

12 12 Alcohol and Homelessness (continued) Study Details Rate of Alcohol Problems Authors U.S., random sample, comparison group 7.41% met DSM- IV criteria NIAAA-NLAES (1992) U.S., homeless men, women, mothers 58-68% men 30% women 10% mothers Fischer & Breakey (1991) U.S., individuals using homeless services 38% current 46% past year 62% life Urban Institute (1999)

13 13 Alcohol and Homelessness (continued) Study Details Rate of Alcohol Problems Authors California, homeless youth 48.4% alcohol users or dependent Robertson, et al., (1989) NYC; soup kitchen; 5+ drinks/day 43% men, 19% women Magura et al. (2000) Rhode Island, sheltered homeless 29.3% lifetime abuse or dependence Glasser & Zywiak (2001)

14 14 Elements for Success  Integrate substance abuse and mental health services  Easy access, avoid transition disruptions  Provide intensive case management  Provide secure, affordable housing at the end of treatment  Use retention enhancement strategies  Respect the culture created by homeless communities (see following slide)

15 15 Culture of the Homeless  Mutual aid, influential central figures emerge (indigenous leadership)  Sense of pride in resourcefulness, independence, fear of being confined (low demand, laissez-faire services)  Need for social contact ©2002 Microsoft Corporation.

16 16 Treatment Approaches 1.Outreach and engagement 2.Motivational interviewing 3.Intensive case management 4.Stabilization & therapeutic communities in shelters 5.Transitional and supportive housing 6.Confronting barriers

17 17 1. Outreach and Engagement  Make contact within homeless milieu  Relate to person in a holistic manner  Offer food and other necessities  Be prepared for advocacy role  Actively make referrals ©2002 Microsoft Corporation.

18 18 2. Motivational Interviewing (MI)  Increase individual’s motivation to change alcohol use/abuse  MI is ideal in settings and critical moments associated with laissez-faire, low demand agencies Express empathy Express empathy Develop discrepancy Develop discrepancy Avoid argumentation Avoid argumentation Roll with resistance Roll with resistance Support self-efficacy Support self-efficacy ©2002 Microsoft Corporation.

19 19 3. Intensive Case Management  Array of activities, coordinated and delivered on regular basis, wherever clients are: Assessment Assessment Continuous service planning Continuous service planning Advocacy Advocacy Benefits acquisition Benefits acquisition Service linkage Service linkage Monitoring Monitoring ©2002 Microsoft Corporation.

20 20 4. Stabilization and Therapeutic Community Programs  Stabilization: Create substance-free zones within shelter environments  Therapeutic Community: Others in recovery become major support network, create therapeutic milieu ©2002 Microsoft Corporation.

21 21 5. Transitional/Supportive Housing  Transitional housing:  Approximately two years of services with housing for successful transition from shelter to permanence  Both are made affordable through grants and subsidies ©2002 Microsoft Corporation.

22 22 Supportive housing:  Bring services into homes social work intervention social work intervention referral referral recreation recreation  Appropriate expectations for involvement and participation tenant organizations tenant organizations ©2002 Microsoft Corporation. 5. Transitional/Supportive Housing (continued)

23 23 Confronting Barriers to Service  Barriers for homeless persons may include:  Prejudice against them  Lack of money, insurance, financial assistance  Difficulty of locating, finding itinerant client ©2002 Microsoft Corporation.

24 24 Confronting Barriers (continued)  Accompanying individual to appointments  Convincing treatment programs to accept individual  Improved diagnosis would extend the scope of services  Address issues such as lack of health care coverage for indigent individuals without program benefits  Work with coalitions and collaborative efforts to influence politics and policy (e.g., state-wide coalitions for homeless) Individual and system-wide advocacy may include:

25 25 Summary  Range of treatment approaches is needed: outreach to formal treatment in shelter settings to transitions out of homelessness  Must be offered in a variety of settings (soup kitchens, shelters, day programs, transitional or supportive housing)

26 26 Summary (continued)  Intervention goals must be flexible –harm reduction approaches –respite and “safe” zones improved –improved screening, assessment, and diagnosis  Homeless individuals must have a say in priorities and program form and function

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